As you read about different areas of sexual functioning,
keep in mind that a problem that developed recently and only occurs in
specific situations will likely be treated differently than a chronic and generalized problem.

Intimacy Problems in Relationships

Problems with sexual intimacy may be an indicator of problems with emotional
intimacy. They may also be due to any of the sexual problems mentioned on this page or
based on misunderstandings about sexual health and functioning. With the demands
of modern life, couples find it difficult to address all the stress and conflicts
that arise between them. Confusing and complicated feelings can drive a wedge
between partners. A problem in the bedroom is often caused when you can’t share
information with your partner about what you need and want. Treatment sessions help
couples better understand each other and facilitate discussion of sensitive areas.

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Low Sexual Desire

Low sexual desire is one of the more challenging sexual
problems. Its cause is often more complex than appears on the surface. Some
contributing factors include health problems, medication, depression, fatigue,
stress, anger, personal history, circumstances particular to your current
relationship, and self-image. More often low desire is due to a complex combination
of factors. Additionally, markedly lower desire in one partner can lead to a
desire discrepancy for couples. If this does not get addressed, it can lead to
more complex relationship problems.

Evaluation for low sexual desire problems may be approached individually or
with both partners. Treatment recommendations are made based upon the specific
nature of the problem.

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Orgasm Difficulties

Both men and women can experience difficulty with orgasms, but women are more
than twice as likely to have these problems. If orgasm is an integral part of your
sexual pleasure and you are unable to maintain control over orgasmic functioning,
a professional can help determine the source of the difficulty. Sometimes it's as
straightforward as a side-effect of medication. For women, it may be due to insufficient
education about the kinds of arousal that lead to orgasm. More complicated sources
that can affect both men and women are due to inhibition, anxiety, trauma, and
substance abuse.

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Sexual Avoidance or Aversion

Unlike low sexual desire, sexual avoidance or aversion is defined by a fearful
or anxious response to being sexual in any way. This can include a negative reaction
to simple hugging, kissing, or even touching. Avoiding sex or experiencing an
aversion to sex affects women more often than it affects men. Such a reaction may
stem from complicated feelings about your body, feelings about sexual performance,
and childhood or adult physical or sexual trauma. Avoidance of sex can be
evaluated and treated whether or not you’re in a relationship.

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Vulvar Pain and Painful Intercourse

Approximately 15% of women experience some form of vulvar and/or vaginal pain.
This pain is due to various conditions, including inadequate lubrication;
vulvodynia or vulvar vestibulitis; vaginitis, endometriosis, and pelvic inflammatory
disease; or fear and anxiety about intercourse. The first step in treatment is a
complete medical exam by a gynecologist familiar with these conditions who can
diagnose and treat the physical aspects of the problem. It is equally important
to treat the stress and relationship problems that inevitably accompany any type
of vulvar pain.

For more information about these conditions and sources of support, check
the following websites:

Vaginismus

Vaginismus is when a woman's pelvic floor muscles constrict
involuntarily and cause reactions ranging from pain to blockage of vaginal
penetration. Pelvic floor muscle pain can be a reaction of fear due to trauma from
prior injury or pain. It can also derive from faulty education about sexuality,
sexual attitudes, or other psychological reasons. As a result, anxiety often becomes
associated with the anticipation of sexual activity, further complicating an
already difficult situation. This condition can be successfully treated and often
includes a combination of psychotherapy and physical therapy with a specialist
in pelvic floor muscles.

Rapid or Inhibited Ejaculation

These two problems represent both sides of difficulty with ejaculation. The
inability to control the timing of ejaculation is probably the most common male
sexual problem. Some estimates say a third of American men experience this. Whether or
not there is a medical basis for the problem, both conditions are marked by
anxiety and a lack of ejaculatory control. Treatment focuses on sexual values and
objectives, the range of normal male sexual functioning, the source of anxiety, and relationship problems.

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Erectile Dysfunction

Formerly known as impotence, erectile problems are a common occurrence in men
of all ages and can happen for many different reasons. Current estimates indicate
that 10% of men have reported inability to maintain an erection.
Such problems can be medical in origin, deriving from side effects of
medication, diseases, and changes with age. On the other hand, erection problems
can be psychological in origin, deriving from anxiety associated with intercourse
or incomplete information on how the penis functions. For example, men might have
unrealistic images of sexual performance, may not achieve adequate arousal, or
try to have sex under poor conditions, such as when stressed, fatigued, or
influenced by alcohol or drugs. Other significant factors stem from relationship
or self-image problems.
It is important to have a complete medical exam by a urologist
familiar with these conditions who can diagnose and treat the physical aspects of
the problem. It is equally important to treat psychological factors and relationship
problems that inevitably accompany erectile dysfunction.

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Gender Identity

Recent research tells us that we have a sense of ourselves as a boy or a girl early in life.
Through history and across cultures, there have always been people who experience
their gender differently from the way others perceive it. They experience a
mismatch between their gender identity and body type. Beginning in the 1990s, the
term transgender was used to describe this difference. Since then newer
terms are being created to more closely capture the various kinds of relationships
people have between their gender identity and their body type, such as gender
variant, gender nonconforming, or genderqueer.

Goals for this work are to sort out any confusion you're having about your
gender identity, determine how you want to integrate your gender identity with
the rest of you, and decide which steps to take toward a more complete sense of
yourself.

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General Psychotherapy

Psychotherapy is a collaborative effort between you and your therapist. It
is a highly confidential and personal way to making changes in your life. In the
broadest sense, psychotherapy is an approach to making better choices for the way
you live. It can help you make sense of things that now don’t make sense. It can
also provide you with a true and honest understanding about the way particular
thoughts, feelings, or behaviors may prevent you from reaching your goals and from
feeling satisfaction.

Psychotherapy is also a valued approach to treating damaging or defeating
patterns of behavior. You may experience these as depression, anxiety, being or
feeling out of control, or being unable to get on track in your life.

The time to consider psychotherapy is when you find something is bothering you
and isn’t resolving itself the way other problems do, or when you feel emotionally
and psychologically restricted. We often sort out distressing thoughts and
feelings by talking to family members and friends, by trying a different approach,
or by finding recreational outlets for the stress, figuring they will pass.
Sometimes they do. But if not, there may be reasons outside of your awareness.
Some areas may seem out of reach or hidden in a blind spot; seeing them clearly
requires a different perspective. In cases like these, psychotherapy can help
you achieve a different outcome with more choices and opportunities.